Deep Plane Facelift in Uberlândia, Brazil

In a SMAS lift — what most patients call a traditional facelift — the skin is elevated off the SMAS and the two layers are handled separately: the SMAS is plicated or sutured and the skin is repositioned over it, along its own vectors. In the deep plane technique, skin and SMAS are raised together and what gets released are the retaining ligaments — the tension sits on the internal sutures rather than on the skin. A systematic review and meta-analysis of 47 studies and 10,766 patients found comparable safety profiles: hematoma in 3% of deep plane cases and 2% of SMAS cases, with similar rates of nerve injury, mostly temporary and rarely permanent. On efficacy, the caveat comes from the study itself: only one paper compared the techniques head to head — and it found superior midface rejuvenation with the deep plane technique — which still does not allow a definitive conclusion about relative efficacy; technique selection remains individual. As a trade-off, the deep plane approach tends to mean longer operating time and dissection closer to nerve structures.

A mini lift is surgery — anesthesia, an incision and a scar — simply with a shorter incision and less dissection, which generally means a less extensive recovery; it suits less advanced laxity and falls short where tissue descent is significant. The endoscopic route is used mainly in the upper third of the face, the forehead and temporal areas, and there are also transtemporal techniques that lift the midface; what it does not reach is the lower third and the neck — jawline laxity and the platysmal bands still call for a different approach. The deep plane facelift works in the deep plane of the middle and lower thirds, releasing the retaining ligaments. Choosing among the three comes from the degree of laxity and the anatomy assessed at the consultation, not from the name of the technique.

They map the same territory in different registers. Rhytidectomy — ritidoplastia in Portuguese — is the technical term, from rhytis, meaning wrinkle. Facelift is the everyday word most patients use. And deep plane is neither a brand nor a device: it names the plane of dissection, the deep plane, lying beneath the SMAS — the superficial musculoaponeurotic system, the tissue layer that envelops the facial musculature. So every deep plane facelift is a rhytidectomy, though not every rhytidectomy is carried out in that plane. In Brazil you will also see it written as ritidoplastia profunda or lifting facial profundo. Which plane makes sense in your case depends on the degree of laxity and on your anatomy, assessed at the consultation.

The deep plane technique works on deeper facial layers, which tends to provide a more natural, longer-lasting result than skin-only techniques.

Because it involves deeper, more meticulous dissection, a deep plane facelift tends to take longer than techniques limited to the skin, varying with the extent of the procedure and whether it is combined with other techniques.

Because the deep plane facelift involves dissection near nerve structures, there is a possible risk of temporary — and, more rarely, permanent — changes in the movement of some facial muscles, which should be discussed individually during the consultation.

Yes, at least one night. A deep plane facelift is major surgery with extensive undermining, and the admission allows bleeding and hematoma — the most frequent complication of this operation — to be observed, pain to be controlled and recovery from the anesthetic to be followed in the first hours. Whether you go home the same day or stay overnight is always assessed case by case, according to the extent of the surgery, the anesthesia, whether other procedures are combined and your pre-operative assessment — and it is defined before the surgery, not on the day. That same decision determines the venue: procedures with same-day discharge are performed in the operating theatre of Healme Clinic itself, and those requiring admission in the operating theatre of the UMC Hospital — in the same complex, with no travel between sites.

General anesthesia is generally used, sometimes combined with sedation, depending on the extent of the surgery and the pre-operative evaluation carried out together with the anesthesiology team.

The most common description is not sharp pain but tightness, heaviness and pulling across the face and neck, alongside patches of numb skin. There is an anatomical reason: the dissection reaches sensory branches in the area, and that temporary loss of sensation itself reduces pain — at the cost of an uncomfortable tingling that can take weeks to months to subside and may, to some degree, never fully resolve. The neck and the area behind the ear are usually the most uncomfortable, particularly when turning the head. Control comes from the prescribed analgesia, keeping the head elevated and relative rest. Strong, increasing pain concentrated on one side is not expected, particularly in the first 24 hours, and should be reported immediately — that is how a hematoma usually presents, generally with rapid, asymmetric swelling of the face or neck alongside it. If there is progressive tightness in the neck, or difficulty breathing or swallowing, the course is not to wait for a reply: seek emergency care. Recognised early, a hematoma is drained; left for later, it can compromise the skin.

The first few days generally call for relative rest with the head elevated, avoiding strain or abrupt neck movements. The exact time varies from case to case.

It varies depending on the type of activity and how swelling and bruising progress — work that doesn't involve physical effort is usually resumed before more demanding roles or ones with greater social exposure.

It's generally necessary to wait until swelling, bruising, and any discomfort with neck movement have subsided, which is assessed individually at follow-up visits.

Light activity is usually reintroduced gradually, while more intense exercise or anything that increases pressure in the facial area should wait longer — the return to exercise is assessed on a case-by-case basis.

Yes, a compression band or dressing is generally recommended during the initial period to help reduce swelling and support the repositioned tissue, as directed by the surgeon.

In general terms, and always varying from case to case: for the first days, a compression band as directed, the head kept elevated and a sensation of tightness and heaviness across the face; between days three and five, swelling peaks and bruises darken before they begin to fade; sutures around the ear are usually removed between day seven and day fourteen. Most of the bruising resolves within the first two to three weeks, and the more visible swelling tends to settle over four to six weeks. What changes after that is subtle: residual swelling and scar maturation carry on for several months. None of these intervals is a rule — each follow-up visit reassesses yours.

Incisions are generally placed in discreet areas, close to the scalp and around the ear's contour, and tend to become less noticeable over time, though healing varies from person to person.

It is major surgery, with defined — and measurable — risks. In a prospective cohort of 11,300 facelifts, the major complication rate — defined as one requiring an emergency room visit, hospital admission or reoperation within 30 days — was 1.8%, with hematoma (1.1%) and infection (0.3%) the most frequent; when surgery was combined with other procedures, that rate rose to as much as 3.7%. That figure comes from an insurance database and counts major complications only: the swelling, bruising and temporary numbness expected after surgery are not in it. A series of 240 deep plane facelifts specifically recorded a 12.5% overall complication rate: transient facial nerve dysfunction in 5.8%, skin necrosis in 2.5%, alopecia — hair loss — along the incision in 1.7% and, each of them under 1%, suture reaction, keloid, hypertrophic scarring, hematoma and a salivary fistula from parotid duct injury. Most of these resolve, but not all: facial nerve change is temporary in the majority of cases and, rarely, permanent, and skin necrosis, alopecia and hypertrophic scarring can leave a sequela that needs treatment of its own. Part of the risk is modifiable: raised systolic blood pressure, the use of aspirin and anti-inflammatories, and smoking appear consistently among the factors associated with hematoma — and smoking weighs above all in another way, accounting for a significant share of the skin losses described after facelift surgery. That is why the preoperative assessment goes through each of those points, and why stopping smoking is usually advised well in advance. The surgeon's experience with the technique also shows in the figures: in that same series of 240 cases, the overall complication rate fell from 16.7% in the first 60 to 8.3% in the last 60, and skin necrosis from 6.7% to no cases at all, which the authors attribute to refinement of the technique with experience.

Venous thromboembolism prophylaxis is used in every patient, not only in those at higher risk. It has two parts. The mechanical one is routine: anti-thrombosis compression stockings and intermittent pneumatic compression of the legs, used during the operation and in the immediate postoperative period, until early ambulation — the third pillar, and the reason the team insists on short, frequent walks from the first hours. The chemical part is individualised: how long enoxaparin is used is defined by the Caprini score, a validated instrument that adds up factors such as age, body mass index, expected length of surgery, hormone use, smoking and personal or family history of thrombosis. None of these measures eliminates the risk, which is why asymmetrical pain or swelling in a leg, shortness of breath and chest pain need immediate assessment, not waiting.

Because it works on deep structures, the result tends to be longer-lasting, though natural aging continues.

Indication depends on the degree of laxity and individual assessment — there is no fixed age for the procedure.

Yes, and the technique is the same — what changes is the planning. Two anatomical differences carry weight. The first is beard-bearing skin: the incision has to be designed so that bearded skin is not carried behind the ear, onto the earlobe or into the ear canal, and that can change the choice between an incision in front of the tragus (pretragal) and behind it (retrotragal) — the tragus being the small cartilage prominence in front of the ear canal. The second is hematoma risk, consistently higher in men across the literature: in a prospective cohort of 11,300 facelifts, male sex was an independent risk factor for hematoma, with a relative risk of 3.9. This does not rule the surgery out; it makes blood pressure control and stopping blood-thinning medication and anti-inflammatories beforehand stricter.

There is no fixed age for the procedure: the criterion is how far the tissues have descended and how lax the retaining ligaments are, assessed individually. One figure helps frame the usual range: in a series of 240 deep plane facelifts — 206 women and 34 men — the mean age was 53.3 years, with a standard deviation of about eight years; that is not a cut-off, simply what is seen most often. At 40 the complaint is usually early laxity along the jawline and a deepening nasolabial fold, and not every degree of laxity at that stage calls for surgery of this extent: less extensive approaches may make more sense. One common belief is worth dispelling — there is no evidence that operating earlier slows ageing down.

It is a medical act. This is surgery involving dissection in the deep planes of the face, close to branches of the facial nerve, carried out in a hospital setting and under anesthesia — outside the scope of dentists, biomedical professionals or aestheticians. In Brazil, anyone performing plastic surgery must hold a CRM registration and an RQE, the specialist qualification registry, in Plastic Surgery, and both can be checked free of charge in the public database of the Brazilian Federal Council of Medicine (CFM). At the consultation it is also legitimate to ask the surgeon about their experience with the technique. The registrations of the physician responsible for this site are CRM-MG 85769 and RQE 71258.

There is no figure that applies to every patient, and the available literature does not answer this question for the deep plane technique specifically. The most quoted measure is indirect and comes from a different context: in a study of 60 patients who underwent face and neck lift surgery — some of them combining blepharoplasty and forehead surgery, and not a deep plane series — raters estimated their age from photographs and perceived the patients as 1.7 years younger than their actual age before surgery and 8.9 years younger afterwards. Three caveats change how that number reads. It is a group average, not an individual forecast. The effect was smaller in the group who had face and neck surgery alone and larger in the group who also had blepharoplasty and forehead surgery — part of the difference comes from combining procedures, not from a technique. And perceived age is not the same thing as ageing, which carries on after surgery. What is reasonable to expect in your case is discussed at the consultation, from your own anatomy.

Surgical fees are always private — Dr. Lorena does not operate through health insurance. What is possible, when a genuine, documented medical indication exists — such as correction of a sequela of facial palsy or of previous injury, on clinical grounds —, is to guide the patient and attempt to have the health plan cover part of the hospital admission, which may include the operating room, the hospital stay and materials, according to the terms of her policy. Authorisation is the insurer's decision and cannot be guaranteed; the team advises on the documentation required and on how to proceed.

No — the SUS does not cover procedures performed for purely aesthetic purposes. Sequelae of facial palsy or of trauma are assessed on clinical grounds, through a different route from the aesthetic one. Dr. Lorena is a plastic surgeon appointed by public examination to the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU) and preceptor of its plastic surgery residency, and she operates on SUS patients there, for reconstructive and functional indications. For those, the route is for the patient to register at the primary care unit (Unidade Básica de Saúde) nearest to her home, be assessed by a doctor there and, if there is an indication, be placed in the regulation queue of her municipality. The surgeon cannot choose who is operated on through the SUS — the order follows the queue and the rules of the system strictly.

We do not publish isolated before-and-after pairs. Resolution 2,336/2023 of the Brazilian Federal Council of Medicine allows results to be demonstrated, but only within a set that also includes unsatisfactory outcomes and the complications described in the literature, across different body types, age ranges and stages of healing, and with no editing of the images (art. 14, II). An isolated pair of photos does not meet those requirements and also implies a guaranteed result, which the same resolution prohibits (art. 11, XII). At the consultation the expected outcome is discussed from your own anatomy — what is reasonable to expect, what is not possible, and what the risks are.

The surgery is carried out in a hospital setting, under anesthesia agreed with the anesthesiology team, through incisions placed in discreet areas: the temporal region, the contour of the ear and the hairline behind it. What defines the technique is not where the incision runs but the layer in which the work is done — the deep plane, lying beneath the SMAS, the superficial musculoaponeurotic system, which is the tissue layer that envelops the facial musculature. In that plane skin and SMAS are raised together as a single composite flap, and it is there that the facial retaining ligaments can be released, among them the zygomatic cutaneous and the masseteric cutaneous ligaments. Those ligaments tether the soft tissue to deeper structures and sit in constant anatomical positions: they stay put while the tissue between them descends over the years, and it is along those lines of anchorage that the folds form — that same tethering is also what prevents the deep planes from being repositioned unless the ligaments are released. They serve, in addition, as anatomical landmarks for how close the facial nerve branches run. Once those points are freed, the flap is repositioned and the support sits on the internal fixation rather than on pulling the skin. When the neck is part of the plan, a separate access under the chin is usually added. How far each stage goes is defined in the individual plan, at the consultation.

What is marketed as a non-surgical facelift refers to technologies and threads that act on skin quality and on mild to moderate laxity — radiofrequency microneedling is one example of what exists in that field. They stimulate collagen and improve texture, but they do not reposition the deep planes and do not remove excess skin: the word lift there describes the intended effect rather than the same procedure. The practical consequence is that where tissue descent is significant and there is excess skin, those routes tend to deliver less than the patient expects; where laxity is mild, they may be enough and make surgery unnecessary. Which route fits your case depends on the examination, not on the name.

In part, and with a distinction worth knowing. The lateral neck is reached through the same incision that runs behind the ear, and repositioning the deep planes already sharpens definition along the jawline. The central neck, however — the platysmal bands, the platysma being the thin muscle that covers the neck, the fat that sits beneath it and deeper structures such as the digastric muscles and the submandibular glands, which produce saliva — usually needs an access of its own, through a small incision under the chin. That step does add risk: in a series of 1,078 facelifts, anterior platysmaplasty was among the factors associated with hematoma. Which is why including the neck is a clinical decision, taken from examining the area rather than from a wish to address everything at once.

A deep plane facelift repositions tissue that has descended. It does not change skin quality: fine lines, uneven texture, pores and sun spots are still there afterwards and are addressed by routes aimed at the skin rather than at support — among them radiofrequency microneedling and laser treatments. Nor does it lift the eyelid or the tail of the brow: those areas belong to blepharoplasty and to surgery of the upper third of the face, which is why these procedures are often combined in one operation. And it does not restore lost volume: where there is loss of malar projection, volume replacement may be considered, whether by filler or fat grafting, assessed case by case. Finally, it does not halt ageing, which carries on. That boundary is part of what is discussed at the consultation.